Early detection of psoriatic arthritis (PsA) can effectively help in reducing the risk of joint damage and disability. Accordingly, the authors offer diagnostic insights in order to improve the approach to the patient's medical history, clinical examination, and the imaging modalities. Early PsA is a condition with a consistent risk of clinical progression. Marked entheseal involvement is a distinctive clinical aspect that helps discriminate early PsA from other conditions observed at their onset, in particular rheumatoid arthritis.